Assessment of the Effectiveness of Continuous Labour Support by a Trained Companion of Choice on Events of Labor and Maternal Satisfaction in the Bugisu Sub Region, Uganda

Not Applicable

Brief Summary: A randomized control trial employing a cross sectional stepped wedge design. Women with anticipated vaginal delivery, receiving usual care for the control group while women receiving usual care plus support from a trained companion will constitute the experimental group. Events and outcomes will then be assessed during and after birth.

Detailed Description: The order of introduction of the intervention will be determined randomly. Control data will be obtained from the first health facility until the sample size for the control for that facility is achieved. Following collection of control data for the first facility, the intervention will be introduced to the same facility to a new group of participants. Simultaneously control data from the other facilities will be collected and this will be done until all the facilities are covered in a step wedge manner.

The intervention will consist of a session of training on admission in labor. The training will focus on emotional and physical support; emotional support including being Present, demonstrating a caring and positive attitude, saying calming verbal expressions, using humor, praise, encouraging and acknowledging efforts during the process of pushing the baby. Physical support including supporting her to change position favoring upright positions, walking with her, giving her drinks and food, massage, reminding her to go and pass urine, helping her find a comfortable position for pushing, wipe her face with cool cloth and help her breast feed.

Recruitment & Eligibility

Inclusion Criteria

Women with a singleton fetus and a supposed cephalic presentation.
Women with a female friend or relative willing to stay with them through the process of labor and birth.

Exclusion Criteria

Arm && Interventions

Group	Intervention	Description
Arm 1	Support from a trained companion	Women are normally escorted to the health facilities by one or more family members and or friends. Women usually labor in an open first stage room where more than one woman is admitted sometimes with curtains to separate the beds with one person allowed besides her to provide support. The support persons do not have designated roles to play during this process. Routine analgesia is not given neither is continuous fetal monitoring. Midwives,
Arm 2	Support from a trained companion	One session of training on admission in labor. The training will focus on emotional and physical support; emotional support including being Present, demonstrating a caring and positive attitude, saying calming verbal expressions, using humor, praise, encouraging and acknowledging efforts during the process of pushing the baby. Physical support including supporting her to change position favoring upright positions, walking with her, giving her drinks and food, massage, reminding her to go and pass urine, helping her find a comfortable position for pushing, wipe her face with cool cloth and help her breast feed

Primary Outcome Measures

Name	Time	Method
Incidence of a Spontaneous Vaginal delivery	labour duration	delivery of the baby naturally without use of oxytocin, vacuum extraction, or a cesarean section

Secondary Outcome Measures

Name	Time	Method
Length of labour	labour duration	From time of admission (4-6cm) to birth
Apgar score	At 1 and 5 minutes	Apgar score of baby at birth
coping and anxiety	labour duration	Women's self-reported anxiety on admission and after birth will be measured using the 10 cm Visual Analogue Scales Coping with labour will be assessed using the Roberts coping with labour algorithm the midwife looks out for cues for coping and not coping
use of oxytocin to augment labor	labor duration	Use of oxytocin to augment labor
Maternal satisfaction questionnaire	Labour duration	Level of satisfaction on support, information, pain control, humaneness and general satisfaction with birthing experience